Social capital, collective action and the water-health nexus in rural Kenya

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Abstract

Access to safe water and adequate sanitation is widely recognised as an important means of protecting public health and human dignity. For example, the introduction of clean water and sewerage disposal (the Sanitary Movement) around the late 19th century in England had significant impacts on disease reduction, especially diarrhoeal diseases and other infectious diseases among marginalised populations. However, similar advancement in water and sanitation coverage has been difficult to achieve in many low and middle-income countries (LMICs) even more than a century and a half later. In recent years, there has been growing emphasis on citizen participation and collective action for initiating and managing community-based water and sanitation related interventions in low resource settings. However, there is limited understanding of the structural and social factors that influence participation in collective action or hinder the success of community based water initiatives.
This thesis explores the influence of social capital on water-health linkages, with emphasis on collective action in Usoma, a rural lakeshore community in Western Kenya. The research focused on three broad objectives: first, to develop a framework for understanding the role of social capital in addressing challenges around water-health linkages in LMICs; second, to determine how social capital mediates the relationships between access to water and participation in collective action; and finally, to explore factors that influence individual and community water related practices and collective action. A mixed-method approach – involving a conceptual review, household survey and photovoice – was used in the research.
The conceptual review suggests that there are two major pathways linking social capital and health within the context of water. First, social capital enhances the success of water-related behavioural interventions that can improve knowledge, behaviours and practices (KAPS). Second, social capital facilitates collective action towards addressing issues related to access to facilities and/or sustainable management of facilities and water resources. Results from the household survey (n=485) reveal that indicators of social capital such as trust and group membership are primary determinants of collective action. Perceptions of differences in landholding and social status were also negatively associated with collective action. Further, findings from the photovoice interviews (n=8) reveal that access to water, perceptions and practices are shaped by broader structural factors such as power relationships, marginalisation and unemployment. Collective actions to improve access were also constrained by institutional and economic structures, thus (re)enforcing inequalities.
This research makes important contributions to knowledge, policy and practice. Theoretically, the research links social capital with ecosocial theory to demonstrate how researchers can connect interactions between environmental risks and (re)actions with broader socio-economic factors to understand environment and health inequalities. The research also developed a framework for understanding how populations literally embody lack of access to safe water and adequate sanitation. This framework can be applied to the embodiment of other environmental risks (e.g., water/air pollution) within similar (or different) context. Methodologically, the research contributes to the conceptualisation and measurement of social capital in a cross-cultural context. The research also provides an effective example of embedded mixed-method design that highlights the strength of mixing quantitative methods with participatory methods such as photovoice. In terms of policy, the research highlights the need for community based water–health interventions to recognise broader policy issues that determine who gets access to water and at what price; as well as micro and macro-level factors that facilitate or constrain social capital, community mobilisation and collective actions.